October 2004

Legislative Watch

By George G. Olsen, JD, and Karina V. Lynch, JD

Back to Back

• Provide coverage to 27 million uninsured—about 95% of the population.
• Build on the current structure of Medicaid and the State Children’s Health Insurance Program (SCHIP) by simplifying enrollment of low-income and moderate-income adults and children.
• Propose to reform the small group insurance market by creating a pool modeled on the Federal Employees Health Benefits Program (FEHBP). Would allow unemployed and older workers, moderate-income employees whose companies do not offer coverage, employers with under 50 employees, and other individuals to buy into this pool with federal assistance. This would cost approximately $952 billion over 10 years and be financed by the elimination of Bush’s tax cuts for high-income households.

• Provide coverage to 6 to 10 million uninsured—20% to 35% of the population.
• Would increase funding for the National Institutes of Health (NIH).
• Provide funding for bioterrorism preparedness.
• Would make premium payments for long-term care insurance fully deductible.
• Increase regulatory flexibility for the states through Health Insurance Flexibility Act waivers.

• Provide a federal stop-loss pool for qualifying employers. Through it, employers would receive approximately a 10% reduction in the cost of their health insurance.
• Would institute tax credits for individuals and small businesses.

• Create a refundable tax credit (provide single individuals up to $1,000 to buy health insurance if they earn $15,000 or less, that phases out at $30,000, and for families would provide up to a $3,000 credit—$30,000 phasing out at $60,000).
• Expand Association Health Plans (AHPs)—a different form of pooling risk that permits and encourages small businesses to offer group-based products.
• Allow individuals to deduct the costs of a qualified high-deductible health care plan.
• Medical malpractice reform proposals.

• Create a “premium rebate pool” designed to make employer-sponsored health coverage more affordable.
• Pool would pick up 75% of annual health care outlays beyond $50,000 per individual. Firms providing health coverage must use this money to lower premiums, cover all their workers, pay 50% or more of the premium, and provide disease management.
• Lower-income people in the pool would not have to pay more than 6% of their income for coverage (they would receive tax credits for amounts beyond this.)

• No analogous proposal.

• Oppose Health Savings Accounts (HSAs).
• Focus on employer-provided insurance.
• Expand SCHIP programs.
• Offer tax credits to small employers (proposed a refundable tax credit of up to 50% of premiums to help small businesses afford health insurance for low and moderate-income workers).
• Subsidize catastrophic costs for all employers.
• Allow some individuals to buy into a pool similar to FEHBP. (Low-income and unemployed persons would qualify for subsidies. Older individuals would be charged “actuarially fair” premiums.)
• For workers between jobs, offer employer’s reinsurance, with the government assuming 75% of all health care costs in excess of $50,000 per year per employee—if the employer offers insurance to all employees and picks up a share of the premium costs.
• Small businesses would receive a tax credit of up to 50% of the cost of premiums for low-income employees—even those who are already insured.

• Have proposed $117 billion in various initiatives to assist those who lack good coverage.
• Make HSA plan premiums tax deductible.
• Offer refundable tax credits to lower-income families—through tax credits a family earning $25,000 or less could receive a “refundable tax credit” of up to $3,000 toward the purchase of health insurance.
• Expand AHPs to encourage individually owned personal and portable health insurance.
• Expand Community Health Centers (CHCs): Would provide $1.5 billion for CHCs, a $114 million increase in order to add 1,200 new and expanded CHCs over 5 years, serving an additional 6.1 million patients; 614 CHCs have been opened.

• Three-point plan that includes: (1) a new Kids Safety Effort requiring safety labels for food allergens and mandatory testing of prescription drugs used for treating children; (2) setting comprehensive standards for early childhood education; and (3) providing health insurance for every child in America.

• Facilitating enrollment in SCHIP.

• Against Bush Medicare plan and moving seniors into Medicare managed care.
• Cosponsored bill to allow Secretary of Health and Human Services to negotiate prices for drugs under the Medicare program.

• Implementation of drug discount cards and low-income assistance until full implementation of Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in 2006.
• CMS to pilot test an online Medicare claims portal that will enable beneficiaries to access personalized information on their health care. CMS will add a feature advising beneficiaries of relevant preventive benefits available to them.
• E-prescribing: The MMA requires Medicare drug plans to use e-prescriptions in January 2009, but CMS intends to have a system in place for e-prescribing when the benefit takes place in January 2006.

• Priority for those with mental illnesses.
• Support full mental health equality.
• Against block granting Medicaid.
• Support $25 billion in state relief.

• Strengthen Medicaid and the SCHIP programs by making available to states an estimated $3.2 billion in unused SCHIP funds, enabling states to expand coverage to the uninsured.
• Would provide $350 million to continue funding Medicaid for families in transition from welfare to work.

• Allow states to extend their buying power beyond Medicaid to other populations.
• Allow reimportation of prescription drugs.
• Disclosure of Pharmacy Benefits Manager discounts. and faster entrance to market for generic drugs.
• Would allow the Secretary of HHS to directly negotiate with drug manufacturers for discounts that would benefit Medicare beneficiaries.
• Support using Medicaid prior authorization mechanisms to secure drug rebates for non-Medicaid populations.
• Endorse pooled purchasing programs within and among states to obtain greater bargaining power in negotiations with drug companies

• Have indicated support for reimportation of drugs, if it can be done “safely.”
• Support the increased use of private-sector health plans to deliver prescription drug benefits to seniors, arguing that competition between private health plans and the traditional fee-for-service Medicare program will lead to lower prices.
• Support the Medicare prescription drug benefit law and promise to ensure that seniors understand the program and get the subsidies to which they are entitled. Want to see implementation in 2006 before determining whether further refinements are needed.

• Want most Americans to have personal electronic medical records within 10 years.
• Proposed increased funding to help states and communities adopt broader health information technology systems.
• Want HHS to work toward setting industry standards for electronic health records. Would use technology to cut waste and lower health care costs while improving quality.
• Would reward providers for investing in technology and taking steps to reduce error and streamline paperwork.

• Goal is for universal health electronic medical records by 2008.
• Propose to reward health care organizations and physicians for investing in modern information systems, especially electronic medical records, patient registries, and patient-reminder systems.
• Rewards would likely come in the form of higher reimbursement rates in public health care programs.
• Recently released HHS Information Technology (IT) framework that outlines a 10-year strategy for integrating IT into the health care system (report due to the HHS Secretary on the costs and benefits of implementation). The four major tenets of the HHS report are: inform clinical practice, interconnect clinicians, personalize care, and improve population health.
• Senate HELP Committee Chairman Gregg (R-NH) introduced legislation the same day that would authorize several of the IT recommendations coming from the Bush Administration. The National Health Information Technology Adoption Act would establish an Office of Health Information Technology within HHS and require federal agencies to meet certain IT standards within 2 years.
• David Brailer, MD, PhD, was recently appointed the National Coordinator for Health Information Technology.

• Would not cap legitimate damage awards and would require an impartial review of a claim before an individual could file suit and would eliminate punitive damages except in “egregious” cases.
• Vice presidential candidate Edwards has proposed applying antitrust laws to insurers, who he believes are responsible for high malpractice premiums that lead to increased health costs.

• Patients could be awarded a maximum for noneconomic damages, such as compensation for pain and suffering, of $250,000.
• Proposes adoption of proven minimum standards related to medical liability.

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